When loved ones are no longer able to stay by themselves or live safely on their own due to physical limitations or cognitive issues, finding home care becomes a top priority.

Most people prefer to stay at home. If you think about it, doesn’t it make sense? We are more comfortable in our own environments, where we can be ourselves and have control over our own lives. 

Supporting a loved one to receive care in their home often means a higher quality of life and can save money over the ever-increasing costs of moving to senior living options like retirement communities, assisted living or nursing facilities. 

Essentially, there are three types of care older adults and people with disabilities can receive at home. No matter which path you take on your search for home care, there are risks and rewards. 

Before we get started, we feel we want to explain something. When we say “home care,” we are talking about assistance with daily living activities, like meal preparation, light housekeeping, and help with dressing. This is non-medical care. It is not the same as “home health care.” MEDICARE DOES NOT COVER HOME CARE (unless you have select Medicare Advantage plans). Medicare only covers “part-time or intermittent skilled nursing care, therapy and other aid that’s determined to be medically necessary and ordered by your doctor. (Source: https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-home-healthcare/) 

Types of In-Home Care

In-Kind Care

This is the care that nobody ever talks about, and so we’re listing it first. It is the care that we family caregivers provide to our loved ones. Oftentimes, we are providing it for free. 

According to Caregiving in the US 2020 Report, “Unpaid caregiving is increasing in prevalence and the U.S. population continues to age and live longer with more complex and chronic conditions. Caregivers feel the push and pull of providing care on their time, their financial well-being, their health, their family, their work, and their own personal well-being. They may find themselves in need of information, resources, benefits, or programs—but these things are often difficult to find or access, or too expensive to afford. Unpaid caregivers are serving as a core piece of the health and LTSS systems, as well as the main source for long-term care for adults living at home and in the community.” (AARP, 16)

The problem with relying only on in-kind care is that it often falls solely on one person, and eventually, caregiving can take its toll. The stress and responsibilities of caring for a loved one can result in poor health outcomes and quality of life for those of us who are providing the care. Another risk of relying only on the care of family caregivers is something we all worry about: what if something happens to them? Who will provide the care then? 

Consumer Directed 

When our loved ones need help, sometimes we look to the people we know in our lives. When we (and our care partners/loved ones) choose the people who provide care, that is called “Consumer Directed” care. 

There are times where those who step up to support us in our caregiving roles provide the “in-kind care” we just described. 

Other times, we are able to access resources to pay them. 

Private Pay

If your loved ones have the resources, they may pay their caregivers privately. 

This is a great option if your loved one can afford it and you’re willing to do a little legwork to get started. Paying caregivers privately means that you and/or your loved one becomes an employer. Just like any other employer, you have duties to carry out to make sure the job gets done. 

In a situation like this, it is advisable to create a contract with your caregivers, as well as a care plan and job description. If you decide to conduct screenings like background checks or use a service to pay your caregivers so you don’t have to manage that responsibility, you (read: your loved one, we advise against spending your own money on your loved one’s care if you can help it) may have to come out of pocket for these expenses. 

If you have a team of family members helping, this may be a great option. If each person takes on a task (ie: one person does the finances, another does the scheduling and hiring), the overall responsibility is not so overwhelming.

It is important to note that any income over $2,600 paid to a household employee (as of 2023), must be reported to the IRS. [To get more information about taxes and household employees, visit https://www.irs.gov/publications/p926]

Your loved one may be able to use long term care insurance, be eligible for public benefits like Medicaid Consumer Directed Services, or even have a private health insurance plan that will  pay someone you choose to provide care as well. 

Caregiver Classifieds

If your social circle is small or you don’t know anyone at all, there are services that can help you find caregivers for hire in your area. This is still technically a way of directing your loved one’s care. You are still responsible for making sure the caregivers are paid, trained on what they need to know to take care of their loved one, and well supported to do their job. 

Examples of these services are Carelinx and Care.com. People who are listed on sites like these are looking for caregiving or companionship work, and many times, they already have caregiving experience. 

All providers that offer this service have different policies and procedures. We suggest doing your research to make sure you know exactly what you’re signing up for.  

For example, Care.com conducts a screening on all caregivers and babysitters who sign up to look for work on their site, but they do not share it with people who use the service to find help. They do, however, offer background checks at additional cost if you find someone you like. 

CareLinx does conduct background checks on all caregivers, but they do not provide them to people searching for caregivers. According to their FAQs, you may ask caregivers to provide a copy. 

These are just a couple examples of “caregiver classifieds.” If you have used a service like this, we’d love to hear from you. Feel free to drop us a line or leave a comment below. 

PS – You may want to check into Papa Pals. We are pretty impressed with this service. It’s just like Uber for people who need a little help at home. You can find a companion who can help with simple tasks or just spend time with your loved one. However, Papa Pals is currently offered to members with select Medicare Advantage, Medicaid, and commercial health plans.

Agency-based services

You may decide that the responsibility of recruiting, screening, training, and supervising caregivers for your loved ones is not for you, and that’s okay. 

The good news is, with some time and proper investigation, you may be able to find a reputable home care agency that can provide caregivers in your loved one’s home. 

The agency will (or should) create a care plan for your loved one, train caregivers on the basics of providing care (although it likely will not be specific to your loved one), and oversee the supervision of caregivers. 

Agency-based services normally accept private payments, but you may also be able to use long-term care insurance or health plans to pay for agency-based home care.  

In Conclusion 

Just like anything else in life, there are pros and cons to every situation. We hope you find a solution that works for you and your family. 

We understand the challenges of navigating the responsibilities of helping a loved one. We’re here for you. Reach out for support if you need it.